Clinical prognosis

临床预后
  • 文章类型: Journal Article
    焦虑症的共病对进化有深远的不利影响,抑郁症的预后和治疗反应性,它将延长抑郁发作缓解所需的时间,与抑郁症患者相比,接受治疗的患者往往会更快地退出治疗方案,但没有焦虑的合并症。这项研究的目的是评估临床的重要性,病因,抑郁症中精神病合并症的存在给预后和特别是治疗的内涵。使用PubMed,Medline,Scopus,谷歌学术和WoS数据库。要选择文章,我们用关键词:精神病合并症,抑郁症和焦虑症,抑郁症和心境恶劣,精神活性物质抑郁症,抑郁症与人格障碍。从精神病学的角度来看,精神障碍的合并症可以分为精神病合并症,当两个或更多不同的精神病存在于同一个人,和医学合并症,当医疗外科疾病与精神障碍有关时。重度抑郁症的存在本身就是广泛性焦虑症后期发作的预测因素。药物滥用或成瘾患者的抑郁症合并症对其临床预后具有深远的影响。人格障碍的关联对重度抑郁症患者的自杀行为有显著影响。
    The comorbidity with anxiety disorders has profound adverse implications on the evolution, prognosis and therapeutic responsiveness of depression, it will prolong the time required to achieve remission of the depressive episode, and patients under treatment will tend to drop out of their therapeutic regimens faster than those with depression but without anxious comorbidity. The purpose of this study is to evaluate the importance of the clinical, etiopathogenetic, prognostic and especially therapeutic connotations given by the presence of psychiatric comorbidities in depression. Articles evaluating the presence of psychiatric comorbidities in depression were analyzed using PubMed, Medline, Scopus, Google Academics and WoS databases. To select the articles, we used keywords: psychiatric comorbidity, depression with anxiety disorders, depression with dysthymia, depression with psychoactive substances, depression with personality disorders. From a psychiatric perspective, the comorbidity of mental disorders can be divided into psychiatric comorbidity, when two or more distinct psychiatric conditions are present in the same individual, and medical comorbidity, when a medical-surgical illness is associated with a mental disorder. The presence of major depression is in itself a predictive factor for a later onset of generalized anxiety disorder. The comorbidity of depression in those with substance abuse or addiction has profound implications on their clinical prognosis. The association of personality disorder has a significant impact on the suicidal behavior of patients with major depression.
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  • 文章类型: Meta-Analysis
    许多研究表明,长链非编码RNA(lncRNA)作为生物标志物来确定多发性骨髓瘤(MM)患者的预后。然而,lncRNAs在MM中的预后作用仍然不明确。在这里,我们进行了一项荟萃分析,以评估MM中异常表达lncRNAs的预测价值.
    在PubMed中进行了系统的文献检索,EMBASE,科克伦,和WebofScience数据库,直到2021年10月9日,该协议已在PROSPERO数据库(CRD42021284364)中注册。我们的研究提取了总生存期(OS)的风险比(HR)和95%置信区间(CI),无进展生存期(PFS),或无事件生存(EFS)。Begg\和Egger\的测试被用来纠正出版偏见。
    本研究纳入了26项包含3501MM患者的个体研究。结果显示,lncRNAs的异常表达与MM患者的不良OS和PFS相关。单变量OS和PFS的合并HR分别为1.48(95%CI=1.17-1.88,p<0.001)和1.30(95%CI=1.18-1.43,p<0.001),分别,而多变量OS和PFS的合并HR分别为1.50(95%CI=1.16-1.95,p<0.001)和1.59(95%CI=1.22-2.07,p<0.001),分别。亚组分析提示MALAT1、TCF7、NEAT1和PVT1上调与不良OS相关(p<0.05),PVT1和TCF7上调与较差的PFS有关(p<0.05),而只有TCF7过表达与EFS降低相关(p<0.05)。此外,轮廓增强漏斗图证明了我们当前结论的可靠性,不受发表偏倚的影响。
    异常表达的特定lncRNAs是长期生存的关键预后指标,也是无进展状态的有希望的生物标志物。然而,不同的截止值和不同的方法来评估lncRNA表达在研究中可能会导致异质性.
    Numerous studies have manifested long noncoding RNAs (lncRNAs) as biomarkers to determine the prognosis of multiple myeloma (MM) patients. Nevertheless, the prognostic role of lncRNAs in MM is still ambiguous. Herein, we performed a meta-analysis to evaluate the predictive value of aberrantly expressed lncRNAs in MM.
    A systemic literature search was performed in PubMed, EMBASE, Cochrane, and Web of Science databases until October 9, 2021, and the protocol was registered in the PROSPERO database (CRD42021284364). Our study extracted the hazard ratios (HRs) and 95% confidence intervals (CIs) of overall survival (OS), progression-free survival (PFS), or event-free survival (EFS). Begg\'s and Egger\'s tests were employed to correct publication bias.
    Twenty-six individual studies containing 3501 MM patients were enrolled in this study. The results showed that aberrant expression of lncRNAs was associated with poor OS and PFS of MM patients. The pooled HRs for univariate OS and PFS were 1.48 (95% CI = 1.17-1.88, p < 0.001) and 1.30 (95% CI = 1.18-1.43, p < 0.001), respectively, whereas the pooled HRs for multivariate OS and PFS were 1.50 (95% CI = 1.16-1.95, p < 0.001) and 1.59 (95% CI = 1.22-2.07, p < 0.001), respectively. Subgroup analysis suggested that MALAT1, TCF7, NEAT1, and PVT1 upregulation were associated with poor OS (p < 0.05), PVT1, and TCF7 upregulation were implicated with worse PFS (p < 0.05), while only TCF7 overexpression was correlated with reduced EFS (p < 0.05). Moreover, the contour-enhanced funnel plot demonstrated the reliability of our current conclusion, which was not affected by publication bias.
    Aberrantly expressed particular lncRNAs are critical prognostic indicators in long-term survival as well as promising biomarkers in progression-free status. However, different cutoff values and dissimilar methods to assess lncRNA expression among studies may lead to heterogeneity.
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  • 文章类型: Journal Article
    背景:胆管癌(CC)中不同分子亚群的识别,随着靶向治疗的日益普及,提示对频繁发生的亚组的患病率和预后的进一步表征可能有助于开发更有效的治疗方法来管理CC.进行了系统评价以调查CC患者异柠檬酸脱氢酶1(IDH1)突变(mIDH1)的患病率。mIDH1的可能的临床和预后意义,以及mIDH1肿瘤中是否存在共突变。
    方法:本综述使用Cochrane双重审查方法和系统评价和荟萃分析方案(PRISMA-P)指南的首选报告项目进行。搜索是在Embase中进行的,MEDLINE,Cochrane中央试验登记册和系统审查数据库,和其他CochraneLibrary资产使用CC和mIDH1的术语,对截至2017年12月31日发表的文章没有语言或日期限制。还对2016年和2017年在以下会议上发表的摘要进行了搜索:美国临床肿瘤学会(ASCO),ASCO-胃肠道癌症研讨会(ASCO-GI),欧洲医学肿瘤学会(ESMO),和ESMO-Asia。筛选由两名评审员分别进行并交叉检查。审稿人之间的任何差异都由高级研究员解决。将来自所有选择的参考的数据记录在数据提取网格中。
    结果:共有46篇出版物符合纳入标准,被纳入系统综述。在这些出版物中,45例报告了在总共5,393例CC患者中mIDH1的频率。mIDH1在肝内CC(ICC)中富集,与552(13.1%;95%CI,12.1-14.2)的4,214例ICC具有突变,而9(0.8%;95%CI,0.4-1.5%)的1,123例肝外CC(ECC)。患有mIDH1CC的女性百分比(66.2%;95%CI,57.7-73.7%)高于整个CC人群(44.4%)。在个别研究中报告的ICC患者中mIDH1的频率范围为4.5-55.6%,与亚洲中心相比,非亚洲中心的频率明显更高(加权平均值,16.5%与8.8%;P<0.001)。美国中心ICC患者mIDH1的患病率为18.0%(95%CI,16.4-19.8%)。11种出版物报道了mIDH1ICC患者的共突变患病率,最常见的是富含AT的含相互作用域的蛋白1A(ARID1A)(22.0%),BRCA1相关蛋白1(BAP1)(15.5%),和PBRM1(13.3%)。八篇出版物研究了mIDH1的可能预后意义。没有一项研究报告mIDH1与总生存期(OS)之间存在统计学上的显着关联。无进展生存期(PFS),或进步的时间。
    结论:本系统综述证实了mIDH1在CC中的患病率,并进一步表征了临床,病理性,和这个亚群中的遗传协变量。共突变数据可能为未来对mIDH1靶向疗法的反应和抗性机制的研究提供信息。
    BACKGROUND: The recognition of distinct molecular subgroups within cholangiocarcinoma (CC), along with the increasing availability of targeted therapies, suggests that further characterization of the prevalence and prognosis of frequently occurring subgroups may assist with the development of more effective treatment approaches for the management of CC. A systematic review was performed to investigate the prevalence of isocitrate dehydrogenase 1 (IDH1) mutations (mIDH1) in patients with CC, the possible clinical and prognostic significance of mIDH1, and the presence of co-mutations in tumors with mIDH1.
    METHODS: This review was conducted using the Cochrane dual-reviewer methodology and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol (PRISMA-P) guidelines. Searches were performed in Embase, MEDLINE, the Cochrane Central Trials Register and Database of Systematic Reviews, and other Cochrane Library assets using terms for CC and mIDH1 with no language or date restrictions for articles published up to December 31, 2017. Searches were also performed of abstracts presented at the following conferences in 2016 and 2017: American Society of Clinical Oncology (ASCO), ASCO-Gastrointestinal Cancers Symposium (ASCO-GI), the European Society for Medical Oncology (ESMO), and ESMO-Asia. Screening was performed separately by two reviewers and cross-checked. Any discrepancies between reviewers were resolved by a senior researcher. Data from all selected references were recorded in a data extraction grid.
    RESULTS: A total of 46 publications met the inclusion criteria and were included in the systematic review. Of these publications, 45 reported the frequency of mIDH1 among a total sample of 5,393 patients with CC. mIDH1 was enriched in intrahepatic CC (ICC), with 552 (13.1%; 95% CI, 12.1-14.2) of the 4,214 patients with ICC having the mutation compared with 9 (0.8%; 95% CI, 0.4-1.5%) of the 1,123 patients with extrahepatic CC (ECC). The percentage of females with mIDH1 CC (66.2%; 95% CI, 57.7-73.7%) was higher than in the overall CC population (44.4%). The frequency of mIDH1 in patients with ICC reported in individual studies ranged from 4.5-55.6%, and a significantly higher frequency was reported in non-Asian centers compared with Asian centers (weighted mean, 16.5% vs. 8.8%; P<0.001). The prevalence of mIDH1 in patients with ICC at USA centers was 18.0% (95% CI, 16.4-19.8%). Eleven publications reported the prevalence of co-mutations in patients with mIDH1 ICC, with the most frequent being AT-rich interactive domain-containing protein 1A (ARID1A) (22.0%), BRCA1-associated protein 1 (BAP1) (15.5%), and PBRM1 (13.3%). Eight publications investigated the possible prognostic significance of mIDH1. None of the studies reported a statistically significant association between mIDH1 and overall survival (OS), progression-free survival (PFS), or time to progression.
    CONCLUSIONS: This systematic review substantiates the prevalence of mIDH1 in CC and further characterizes clinical, pathologic, and genetic covariates within this sub-population. Co-mutation data may inform future studies of mechanisms of response and resistance to mIDH1-targeted therapies.
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